REPUBLIC OF THE PHILIPPINES )

PROVINCE OF TARLAC ) S.S.

MUNICIPALITY OF PANIQUI )

AFFIDAVIT OF DISCREPANCY

I, HIERONEDES COSGAFA NARBAY, of legal age, Filipino, married with postal address at
Barangay Ambassador Alzate Village, Nampicuan, Nueva Ecija, after having been duly sworn to
according to law hereby depose and state:

1. That I am the biological father of HIERA KIM RILLORAZA NARBAY, who was
born on May 29, 1994 at St. Rose Hospital, Samput, Paniqui, Tarlac;

2. That in my daughter’s Certificate of Live Birth, issued by the Philippine Statistics

Authority (PSA), the entry with respect to her “GENDER” was erroneously marked with
“X” as MALE, as it should be FEMALE, as she is physically and biologically a female;

3. That the error as regards to my daughter’s gender was due to some honest mistake in typing
the said entry, without any malicious intent or purpose and was not done in bad faith;

4. That the names HIERA KIM RILLORAZA NARBAY, who entered as a MALE, as
per Certificate of Live Birth, issued by the Philippine Statistics Authority (PSA) and
HIERA KIM RILLORAZA NARBAY, who is physically and biologically a
FEMALE, refers to one and the same person;

5. That I am executing this affidavit in order to attest to the truth of the foregoing
circumstances, and for all legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 17 th day of January, 2018, at
Paniqui, Tarlac.

HIERONEDES COSGAFA NARBAY

Affiant

SUBSCRIBED and SWORN to before me, in the Municipality of Paniqui, Province of Tarlac, this
17th day of January, 2018, by Hieronedes Cosgafa Narbay, personally known to me and who in person
signed before me the foregoing affidavit. Affiant exhibited to me his Senior Citizens ID No. 2845,
bearing his name, picture and signature as proof of his identity.

Doc. No. _______;

Page No. _______;
Book No._______;
Series of 2018